title: Patient selection for day case-eligible surgery: identifying those at high risk for major complications.
abstract: BACKGROUND
  Due to economic pressures and improvements in perioperative care, outpatient surgical procedures have become commonplace. However, risk factors for outpatient surgical morbidity and mortality remain unclear. There are no multicenter clinical data guiding patient selection for outpatient surgery. The authors hypothesize that specific risk factors increase the likelihood of day case-eligible surgical morbidity or mortality.
  
  
  METHODS
  The authors analyzed adults undergoing common day case-eligible surgical procedures by using the American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2010. Common day case-eligible surgical procedures were identified as the most common outpatient surgical Current Procedural Terminology codes provided by Blue Cross Blue Shield of Michigan and Medicare publications. Study variables included anthropometric data and relevant medical comorbidities. The primary outcome was morbidity or mortality within 72 h. Intraoperative complications included adverse cardiovascular events; postoperative complications included surgical, anesthetic, and medical adverse events.
  
  
  RESULTS
  Of 244,397 surgeries studied, 232 (0.1%) experienced early perioperative morbidity or mortality. Seven independent risk factors were identified while controlling for surgical complexity: overweight body mass index, obese body mass index, chronic obstructive pulmonary disease, history of transient ischemic attack/stroke, hypertension, previous cardiac surgical intervention, and prolonged operative time.
  
  
  CONCLUSIONS
  The demonstrated low rate of perioperative morbidity and mortality confirms the safety of current day case-eligible surgeries. The authors obtained the first prospectively collected data identifying risk factors for morbidity and mortality with day case-eligible surgery. The results of the study provide new data to advance patient-selection processes for outpatient surgery.
authors.affiliation: * Anesthesiology Resident, † Associate Professor, ‡ Research Associate, ‖ Assistant Professor, Department of Anesthesiology, Center for Perioperative Outcomes Research, § Plastic Surgery Chief Resident, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mathis
authors.forename: Norah N
authors.initials: NN
authors.lastname: Naughton
authors.forename: Amy M
authors.initials: AM
authors.lastname: Shanks
authors.forename: Robert E
authors.initials: RE
authors.lastname: Freundlich
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pannucci
authors.forename: Yijia
authors.initials: Y
authors.lastname: Chu
authors.forename: Jason
authors.initials: J
authors.lastname: Haus
authors.forename: Michelle
authors.initials: M
authors.lastname: Morris
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D000758:Anesthesia; D000886:Anthropometry; D016208:Databases, Factual; D005260:Female; D005544:Forecasting; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D058996:Quality Improvement; D018570:Risk Assessment; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D055815:Young Adult